ED Coding and Reimbursement Alert

Question: We are an outpatient wound care center in a hospital setting. Our physicians do their billing out of their own offices, and we input the charges into the hospital system for the hospital partner to do the billing. We are doing clinical sharp debridements on a weekly basis. Should I be charging an office visit and a debridement, or should these charges be bundled together? The physician is charging for both, but I am not sure if this is the correct practice for the facility. Although our nurse is in the room with the physician during the procedure, she is not doing the procedure. The facility is charging for both, and the physician is also charging for both. Is this considered double charging?

Vicki Taylor
Curative Health Services, St. Louis

Answer: Assuming your physicians are correctly reporting the place of service as outpatient hospital on their professional claims, this would not be considered double charging. The physicians claim represents the professional part, and the hospitals claim represents the technical part of the services provided.

Although only the physician is performing the debridement, the room and supplies are being provided by the facility. If the physician is renting office space from the hospital, he or she would report the place of service as providers office, and the hospital would not submit any claim for services provided in the rented office space.

The source for this Reader Question is Laura Siniscalchi, RRA, CCA, CCS-P, CPC, education coordinator for Beth Israel Deaconess Medical Center in Boston.